Atlas of Male Reproductive Pathology

80 Pages·1985·39.69 MB·English

by  I. D. Ansell (auth.)

Atlas of
Male Reproductive
Pathology
Current Histopathology
Consultant Editor
Professor G. Austin Gresham, TO, SeD, MO, FRC Path.
Professor of Morbid Anatomy and Histology, University of Cambridge
Volume Ten
@CS
&u[S&~
MALE REPRODUCTIVE
PATHOLOGY
BY I. D. ANSELL
Consultant Histopathologist
Department of Pathology
City Hospital
Nottingham
l\+I.TP PRESS LIl\+I.ITED
~.
"-\i.l,''''~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP . ,
LANCASTER / BOSTON / THE HAGUE / DORDRECHT
Published by
MTP Press Limited
Falcon House
Queen Square
Lancaster, England
Copyright© 19851. D. Ansell
Softcover reprint of the hardcover 1st edition 1985
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, ortransmitted
in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without prior
permission from the publishers.
British Library Cataloguing in Publication Data
Ansell, I. D.
Atlas of male reproductive pathology.-(Current
histopathology; v. 10)
1. Generative organs, Male-Diseases
I. Title II. Series
612'.61 RC875
ISBN-13: 978-94-010-8654-7 e-ISBN-13: 978-94-009-4868-6
DOl: 10.1007/978-94-009-4868-6
Published in the USA by
MTP Press
Adivision of Kluwer Boston Inc
190 Old Derby Street
Hingham, MA 02043, USA
Library of Congress Cataloging in Publication Data
Ansell, I. D. (Ian David)' 1938-
Atlas of male reproductive pathology.
(Current histopathology; v. 10)
Includes bibliographies and index.
1. Generative organs, Male-Diseases-Atlases.
2. Generative organs, Male-Biopsy-Atlases.
3. Histology, Pathological-Atlases. I. Title.
II. Title: Male reproductive pathology. III. Series.
[DNLM: 1. Genital Diseases, Male-pathology
atlases. Wl CU788JBA v. 10/ WJ 17 A618al
RC877 .A57 1985 616.6'5 85-2475
ISBN-13: 978-94-010-8654-7
Photoset and printed by Redwood Burn Limited
Trowbridge, Wiltshire
Bound by Butler and Tanner Limited, Frome and London
Contents
Consultant editor's note 7
Preface 9
Acknowledgements 10
Introduction 11
1 Testis-embryology and normal structure 13
2 Testis - developmental abnormalities 17
3 Testicular biopsy 21
4 Testis - germ cell tumours - general
considerations 25
5 Testis-seminoma 29
6 Testis - non-seminomatous germ cell
tumours-1 33
7 Testis-non-seminomatous germ cell
tumours-2 37
8 Testis-non-germ-cell tumours 41
9 Testis - inflammatory conditions 45
10 Epididymis 49
11 Vas and seminal vesicles 53
12 Prostate-normal and hyperplasia 57
13 Prostate - carcinoma 61
14 Prostate-rarer tumours 65
15 Prostate - inflammatory conditions 69
16 Penis, urethra and scrotum - benign
conditions 73
17 Penis, urethra and scrotum - malignant
conditions 77
Index 81
Current Histopathology Series
Already published in this series:
Volume 1 Atlas of Lymph Node Pathology
Volume 2 Atlas of Renal Pathology
Volume 3 Atlas of Pulmonary Pathology
Volume 4 Atlas of Liver Pathology
Volume 5 Atlas of Gynaecological Pathology
Volume 6 Atlas of Gastrointestinal Pathology
Volume 7 Atlas of Breast Pathology
Volume 8 Atlas of Oral Pathology
Volume 9 Atlas of Skeletal Muscle Pathology
Other volumes currently scheduled in this series include
the following titles:
Atlas of Articular Pathology
Atlas of Cardiovascular Pathology
Atlas of General Cytology
Atlas of Connective Tissue Pathology
Atlas of Neuropathology
Atlas of Ophthalmic Pathology
Atlas of Skin Pathology
Atlas of Toxicology
Consultant Editor's Note
At the present time books on morbid anatomy and niques which should be within the compass of the
histology can be divided into two broad groups: exten worker in a unit with reasonable facilities.
sive textbooks often written primarily for students and (3) New types of material. e.g. those derived from
monographs on research topics. endoscopic biopsy should be covered fully.
This takes no account of the fact that the vast majority (4) There should be an adequate number of illus
of pathologists are involved in an essentially practical trations on each subject to demonstrate the vari
field of general Diagnostic Pathology providing an im ation in appearance that is encountered.
portant service to their clinical colleagues. Many of (5) Colour illustrations should be used wherever they
these pathologists are expected to cover a broad range aid recognition.
of disciplines and even those who remain solely within
The present concept stemmed from this definition but it
the field of histopathology usually have single and sole
was immediately realized that these aims could only be
responsibility within the hospital for all this work. They
achieved within the compass of a series. of which this
may often have no chance to direct discussion on prob
volume is one. Since histopathology is. by its very
lem cases with colleagues in the same department. In
nature. systemized. the individual volumes deal with
the field of histopathology. no less than in other medical
one system or where this appears more appropriate
fields. there have been extensive and recent advances.
with a single organ.
not only in new histochemical techniques but also in the
This atlas provides a modern account of the pathology
type of specimen provided by new surgical procedures.
of the male reproductive organs. It aims to provide an
There is a great need for the provision of appropriate
account of biopsy interpretation of specimens common
information for this group. This need has been defined in
ly encountered by the practising histopathologist. This
the following terms.
aim has been most satisfactorily achieved and has pro
(1) It should be aimed at the general clinical patholo vided another useful bench manual in this series.
gist or histopathologist with existing practical Experienced histopathologists and those in training will
training. but should also have value for the trainee find it a valuable addition to the library in the reporting
pathologist. room.
(2) It should concentrate on the practical aspects of G. Austin Gresham
histopathology taking account of the new tech- Cambridge
Preface
This atlas deals with conditions commonly encountered
in the male genital tract. Whilst the majority of illustra
tions are photomicrographs, photographs of macro
scopic specimens are also used to illustrate important
features in distinguishing different pathological con
ditions. Special emphasis is placed on the small biopsy
specimens obtained from prostate and testis in modern
urological practice and the importance of clinico
pathological co-operation in pathological practice is
stressed. Recent advances in our knowledge of testicu
lar tumours are discussed and illustrated. The text is not
entirely descriptive and attempts to give an intellectual
framework around which histopathological diagnosis in
this field can be practised. A modest number of
references are included; they have not been singled out
as representing milestones in the development of our
knowledge of these conditions - the choice has rather
more centred upon recent reports from which a litera
ture search can be mounted if required. The atlas in no
way pretends to be an encyclopaedic reference of con
ditions of the male genital tract but attempts to provide
an up-to-date comprehensive discussion of the histo
pathology of this system.
Acknowledgements
I am most grateful to Mr Keith Gordon for developing all
the photomicrographs and to Mr Geoff Gilbert and his
staff in the Audio-Visual Department of the City Hospital
who took the majority of the macroscopic illustrations. I
must particularly thank my secretary, Mrs Dorothy Clay
ton, for typing and retyping my draft chapters and for
deciphering my hieroglyphics.
Introduction
At first glance urological pathology is not obviously a ated by the general surgeon with an interest in urology
subject in which there have been great advances in of 30 years ago. Prostates are now resected transure
recent years. Electron microscopy and immunological thrally in the vast majority of instances and the material
techniques have not revolutionized our concepts of dis sent for examination is accordingly that much more diffi
ease in this area, as has occurred in renal glomerular dis cult to orientate and indeed to diagnose. Biopsy tech
ease or in tumours of the Iymphoreticular system. niques are also widely employed - for example needle
However, there have been great changes in urological biopsy of abnormal areas within the prostate and tes
practice over the last 20-30 years. Urology as a disci ticular biopsy in the investigation of infertility - and
pline is no longer practised only in the larger cities and although these specimens are not as small as those
most District General Hospitals are likely to have a urolo obtained by such techniques as bronchoscopy and
gist trained in a centre where specialized histopathologi endoscopy they can certainly pose their own difficulties
cal advice was available. Such urologists are well in interpretation. The discovery of marker substances,
acquainted with many of the entities described and dis both within tumours themselves and in serum, has com
cussed in this book and will expect the local histopath pletely revolutionized our thoughts on the classification
ologist to be able to recognize them when he and indeed the treatment of testicular tumours and tech
encounters them in his clinical practice. Modern urologi niques to apply this knowledge to diagnostic histopath
cal practice produces a completely different spectrum ology are now available to all departments.
of pathological specimens compared to those gener-
1
Testis - Embryology and Normal Structure
The testes ar~ the prim~ry generative organs of the Embryology
male and are situated outside the peritoneal cavity in the
T~e t~stes develop from the medial aspect of the uroge
scrotum. There IS now good evidence that the lower
nital ridge on the dorsum of the coelomic cavity of the
tempera.ture in this site is required for effective sperma
early embryo in the region of the mesonephros (Plate
togenesIs. The organ has two essential functions the
production of spermatozoa and the production of ~ale ~ .2). The primordial germ cells migrate from their origin
In the yolk sac along the midline to reach this area and
sex hormones.
then move laterally to the genital ridge, ventromedial to
Spermatozoa are produced in the 600 or so coiled
the mesonephros. Proliferation of coelomic epithelium
seminiferou~ t~bules within the main body of the testis; of the gonadal primordium forms the cortex whilst the
these lie within the separate fibrous compartments
medulla is derived from multiplication of the mesenchy
formed by extensions of fibrous tissue from the external
malcells.below thiS. The medullary cells form solid epi
~oat, th~ tunica albugi.nea, inwards and posteriorly to the thelial primary sex cords into Which, in the male, the
fibrous tissue at the hilum, the mediastinum testis (Plate
g~rm ce!ls rr:'igrate. The medullary mesenchymal cells
1.1). As the tubules approach the hilum they straighten
differentiate Into the supporting cells of the tubules, the
out to become the tubuli recti which then anastomose
Sertoll cells, and the hormone-producing interstitial cells
freely within the mediastinum as the rete testis. From
betw~en them, the Leydig cells. The medial portions of
the rete testis a dozen or so ductuli efferentes pass into
the primary sex cords develop into the rete testis which
the head of the epididymis (situated posterior to the
then links up with mesonephric tubules which form the
bo~y of the testis) and then fuse to form the single epididymis. The vas is derived from the mesonephric or
cOiled ductus deferens which passes downwards to
Wolffian duct. The cells of the cortex form the cellular
form the tail of the epididymis. The duct then passes
cov~ring ~f the testis, the tunica vaginal is, and the con
upwards again outside the testis as the vas deferens
~ectlve tissue b~tween. cortex and medulla develops
within the spermatic cord on its way to the seminal vesi
Int? the dense ~Ibrous t~ssue of the tunica albuginea.
cle. Further description of the epididymis and vas will be
ThiS embryological origin of the testis from upper
found in Chapters 10 and 11.
Mesonephric tubule
Head of epididymis
Testicular artery
Vas deferens o;;-:;;:::=::r'l-l---+-+'-Mesoneph ri c
(Wolffian duct)
Ductuli efferentes
Tunica
albuginea Tubu I i recti
Ductus epididymis
Septa -----l~~~~ .......,..-ffi~--#-- Rete testis in
mediastin urn
I COELOMIC
I CAVITY
Seminiferous _---l~ I
tubule
I
I
Tail of epididymis
Plate 1.1 Structure of the testis Plate 1.2 Embryogenesis of the testis